Organization
GREGG T. PODLESKI, D.O. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGG THOMAS PODLESKI D.O., P.A. (OWNER / CEO)
(972) 613-7776
Entity
Organization
Contact information
Practice address
2540 N GALLOWAY AVE, SUITE 302, MESQUITE, TX 75150-6306
(972) 613-7776
(972) 613-7775
Mailing address
PO BOX 851858, MESQUITE, TX 75185-1858
(972) 613-7776
(972) 613-7775
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
J7138
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03034994601
—
TX
01
—
180405500
DOL ACS
TX
01
—
3342342
BLUE LINK
TX
01
—
4570998
AETNA PIN
TX
01
—
N35U
BLUE CROSS PROVIDER
TX
Enumeration date
09/01/2009
Last updated
09/01/2009
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